WASHINGTON, March 28 (UPI) -- In 2008, 24 states reported 20 percent or more of their residents said they could not afford needed healthcare, but in 2013, this dropped to 16 states, a Gallup poll found.

The Gallup-Healthways Well-Being Index asked 178,000 U.S. adults from Jan. 2 to Dec. 29, 2013, if there were times in the past 12 months when they did not have enough money to pay for healthcare and/or medicine they and their families needed.

In 2013, 18.6 percent of Americans said they had trouble affording healthcare or medicine compared to the national average of 19.7 percent in 2008.

Last year, the states that struggled the most to afford medical care and medications were: Alabama, West Virginia, Mississippi, Kentucky and North Carolina. More than 24 percent of people living in Alabama said in the past 12 months they did not have enough money to pay for medical care or medications.

Iowa and Minnesota tied for the lowest percentage of residents who were unable to afford needed healthcare or medicine, at 12.2 percent, followed by: Hawaii, North Dakota and Massachusetts.

Lacking healthcare coverage was not a perfect predictor of Americans' ability to afford needed healthcare in a given state. Although the uninsured rates in Alabama and West Virginia are above average, they were not among the top 10 states lacking health insurance coverage.

The margin of error for most states was 1 percentage point to 2 percentage points, but small states such as Delaware and Wyoming had a margin of error as high as 4 percentage points.

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